Head & Neck Cancer (Dr. Mao)

Question 1

Potential Skin and Mucosal sites for head/neck cancer

Answer 1

-nose cavity -paranasal sinuses -oral cavity -pharynx -larynx -thyroid glands -salivary glands

Question 2

essentials of H&N cancer for PAs

Answer 2

-early diagnosis!!! (recognizing tumors) -pt. support -post-treatment surveillance (recognize tumor recurrence) -modifying causative patient behaviors (tumor prevention)

Question 3

second most common skin cancer

Answer 3

squamous cell carcinoma

Question 4

most common skin cancer

Answer 4

basal cell carcinoma

Question 5

how does basal cell carcinoma spread?

Answer 5

spreads by local invasion (gets bigger and bigger), but does not tend to metastasize to distant sites

Question 6

characteristics of BCC (how it looks)

Answer 6

-open sores -pearly! shiny bumps -red patch/pink growth -raised

Question 7

SCC presentation (how it looks)

Answer 7

-tend to be ulcerated -scaly -elevated growths with central depressions

Question 8

Where does malignant melanoma originate?

Answer 8

melanocytes

Question 9

Important acronym for diagnosis of malignant melanoma

Answer 9

Assymetric Border irregularity Color variation/multiple Diameter >6mm Enlarging, evolving

Question 10

Types/names of malignant melanoma

Answer 10

-superficial spreading -lentigo melanoma -acral lentiginous -nodular

Question 11

staging melanoma is based on

Answer 11

depth of invasion -clark’s levels or Breslow’s

Question 12

Risk factors of skin cancer

Answer 12

-sun exposure -# moles -fam hx -immunocompromised (like kaposi’s sarcoma, etc) -precancerous lesions like actinic keratosis or dysplastic nevi

Question 13

Presenting signs of cancer

Answer 13

-non-healing ulcer -enlarging mass, neck mass -pain -hoarseness, dysphagia -anosmia, nasal obstruction, serous otitis, cranial neuropathies, otalgia

Question 14

risk factors of cancer

Answer 14

-tobacco & alcohol -viral (HPV, EBV) -immune suppression -nutritional deficiencies -occupational exposure like woodworking -gastroesophageal reflux

Question 15

How much greater is risk of H&N cancer in smokers with nonsmokers

Answer 15

5-35x greater in smokers

Question 16

___% of patients with H&N cancer smoke tobacco

Answer 16

85-90%

Question 17

Alcohol increases risk of cancer by how much

Answer 17

2-15x

Question 18

_________ are synergistic carcinogens

Answer 18

alcohol and tobacco

Question 19

Potentially premalignant lesions in the head and neck

Answer 19

-leukoplakia -erythroplakia -actinic keratoses of skin -squamous carcinoma in situ -dysplasia -verrucous hyperplasia

Question 20

T in TNM staging system

Answer 20

T (0-4)

-size or characteristics of primary tumor

Question 21

N in TNM staging system

Answer 21

N (0-3)

-size & location of cervical lymph node metastases

Question 22

M in TNM staging system

Answer 22

M (0-1)

-distant metastases

Question 23

Answer 23

SCC of tongue

Question 24

Answer 24

SCC of maxillary alveolar ridge

Question 25

Answer 25

SCC of lip

Question 26

Answer 26

SCC of Lip

Question 27

Answer 27

SCC floor of mouth

Question 28

Answer 28

SCC of buccal mucosa

Question 29

Answer 29

Leukoplakia

Question 30

Answer 30

actinic keratosis (precancer)

Question 31

Answer 31

Kaposi's sarcoma

Question 32

Answer 32

mucosal melanoma

Question 33

presentation of salivary gland malignancies

Answer 33

- present as gradually enlarging, painless mass - facial nerve weakness

Question 34

risk factors of savilary gland malignancy

Answer 34

risk factors: radiation

Question 35

sx/presentation of thyroid gland malignancies

Answer 35

- painless enlarging mass - compressive sx - hoarseness

Question 36

risk factors for thyroid gland malignancy

Answer 36

- prior radiation - fam hx - iodine deficiency

Question 37

work up for h&n cancers

Answer 37

thorough h&p - fiberoptic exam of pharynx & larynx - imaging- CT WITH contrast, U/S, PET-CT - needle aspiration/ biopsy - staging endoscopy anf further biopsy

Question 38

treatment options for H&N cancers

Answer 38

- surgical excision - radiation therapy - chemo - radioactive iodine - combinations

Question 39

What does neck dissection control/ why would you do neck dissection in H&N cancers?

Answer 39

- control lymph node metastasis - surgical removal of lymph nodes

Question 40

Reconstructive options for H&N cancer

Answer 40

- primary closure - flaps - skin grafting - bone grafting

Question 41

How is radiation therapy typically given for H&N cancer

Answer 41

typically given as photon (cobalt) radiation

Question 42

Complications of radiation therapy for H&N cancer

Answer 42

- dry mouth (xerostomia), increased dental & periodontal disease), osteoradionecrosis-mandibular bone

Question 43

typical treatment regimen for radiation therapy for H&N cancer

Answer 43

- 200cGy fractions - once per day - five days per week - 6-7 weeks

Question 44

Typical agents of chemotherapy for H&N cancers

Answer 44

-cisPlatinum, 5-Fluorouracil (5FU), methotrexate

Question 45

complications of chemo for H&N cancers

Answer 45

-include mucositis, nausea, vomiting, hearing loss, decreased immunity

Question 46

Treatment of well-differentiated thyroid cancer

Answer 46

- total thyroidectomy - ablative dose of radiactive iodid (4-6 weeks later)

Question 47

tx of Medullary carcinoma (thyroid cancer)

Answer 47

- doesn't resond to I-131 - occasionally radiated

Question 48

tx of undifferentiated carcinoma (thyroid cancer)

Answer 48

-carries poor prognosis regardless of tx

Question 49

Notes on prognosis in H&N cancers

Answer 49

- generally higher stage = poorer prognosis - 5 yrs tumor free, generally means cured for SCC - pt's MUST stop smoking for a chance at good prognosis

Question 50

Answer 50